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Journal of Orthopaedic Surgery and... Jun 2023To investigate the clinical outcomes of percutaneous vertebroplasty (PVP) versus percutaneous vertebroplasty combined with pediculoplasty (PVP-PP) for Kümmell's disease... (Observational Study)
Observational Study
BACKGROUND
To investigate the clinical outcomes of percutaneous vertebroplasty (PVP) versus percutaneous vertebroplasty combined with pediculoplasty (PVP-PP) for Kümmell's disease (KD).
METHODS
Between February 2017 and November 2020, 76 patients with KD undergoing PVP or PVP-PP were included in this retrospective study. Based on the PVP whether combined with pediculoplasty, those patients were divided into PVP group (n = 39) and PVP-PP group (n = 37). The operation duration, estimated blood loss, cement volume, and hospitalization stays were recorded and analyzed. Meanwhile, the radiological variations including the Cobb's angle, anterior height of index vertebra, and middle height of index vertebra from X-ray were recorded preoperatively, at 1 days postoperatively and the final follow-up. The visual analogue scale (VAS) and Oswestry disability index (ODI) were also evaluated. Preoperative and postoperative recovery values of these data were compared.
RESULTS
The two groups showed no significant difference in demographic features (p > 0.05). The operation time, intraoperative blood loss, and time of hospital stay revealed no sharp statistical distinctions either (p > 0.05), except that PVP-PP used more bone cement than PVP (5.8 ± 1.5 mL vs. 5.0 ± 1.2 mL, p < 0.05). The anterior and middle height of vertebra, Cobb's angle, VAS, and ODI was observed a little without significant difference between the two groups before and 1 days postoperatively (p > 0.05). Nevertheless, ODI and VAS scores decreased significantly in the PVP-PP group than in the PVP group at follow-up (p < 0.001). The PVP-PP group exhibited a slight amelioration in Ha, Hm, and Cobb's angle when compared to the PVP group, displaying statistical significance (p < 0.05). No significant disparity in cement leakage was observed between the PVP-PP and PVP groups (29.4% vs. 15.4%, p > 0.05). It is worth noting that the prevalence of bone cement loosening displayed a remarkable decrement within the PVP-PP group, with only one case recorded, as opposed to the PVP group's seven cases (2.7% vs. 17.9%, p < 0.05).
CONCLUSIONS
Both PVP-PP and PVP can relieve pain effectively in patients with KD. Moreover, PVP-PP can achieve more satisfactory results than PVP. Thus, compared with PVP, PVP-PP is more suitable for KD without neurological deficit, from a long-term clinical effect perspective.
Topics: Humans; Retrospective Studies; Bone Cements; Spondylosis; Spine; Vertebroplasty
PubMed: 37386585
DOI: 10.1186/s13018-023-03957-5 -
Journal of Musculoskeletal & Neuronal... Jun 2024To investigate the effects of the combined application of percutaneous vertebroplasty and zoledronic acid on bone mineral density (BMD), bone metabolism, neuropeptide Y...
Effects of Combined Application of Percutaneous Vertebroplasty and Zoledronic Acid on Bone Mineral Density, Bone Metabolism, NPY and PGE2 in Elderly Patients with Osteoporotic Lumbar Vertebral Compression Fracture.
OBJECTIVE
To investigate the effects of the combined application of percutaneous vertebroplasty and zoledronic acid on bone mineral density (BMD), bone metabolism, neuropeptide Y (NPY) and prostaglandin E2 (PGE2) in elderly patients with osteoporotic lumbar vertebral compression fracture (OVCF).
METHODS
The medical records of 118 elderly patients with OVCF who received treatment at our hospital from March 2018 to March 2020 were collected and analyzed retrospectively. Vertebral body height, spinal function, pain degree, and lumbar BMD were compared between the two groups upon admission and three years after the operation. Additionally, the levels of bone-specific alkaline phosphatase (BALP), 25-hydroxyvitamin D (25-(OH)D), beta collagen degradation fragments (β-CTx), neuropeptide Y (NPY), and prostaglandin E2 (PGE2) in the two groups were measured at admission and three years after the operation. Furthermore, complications in the two groups within three years after the operation were documented.
RESULTS
After three years post-operation, the combination group showed a significantly greater improvement in vertebral body height compared to the control group (P<0.05). Moreover, the combination group exhibited a significantly lower Oswestry Disability Index (ODI) score compared to the control group (P<0.05).
CONCLUSION
In elderly patients with OVCF, the combined use of zoledronic acid and percutaneous vertebroplasty is effective in improving lumbar function, BMD, and bone metabolism indices, while reducing pain and the levels of NPY and PGE2.
Topics: Humans; Aged; Female; Fractures, Compression; Zoledronic Acid; Male; Vertebroplasty; Lumbar Vertebrae; Dinoprostone; Bone Density; Spinal Fractures; Neuropeptide Y; Osteoporotic Fractures; Aged, 80 and over; Bone Density Conservation Agents; Retrospective Studies; Combined Modality Therapy
PubMed: 38826002
DOI: No ID Found -
BMC Musculoskeletal Disorders Nov 2023The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates...
BACKGROUND
The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP).
OBJECTIVE
The research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes.
METHODS
A comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05).
CONCLUSION
In juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.
Topics: Humans; Aged; Vertebroplasty; Fractures, Compression; Bone Cements; Spinal Fractures; Treatment Outcome; Kyphoplasty; Osteoporotic Fractures; Retrospective Studies
PubMed: 37996830
DOI: 10.1186/s12891-023-06997-4 -
Journal of Clinical Medicine Sep 2023Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the... (Review)
Review
Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab.
Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise.
PubMed: 37762815
DOI: 10.3390/jcm12185874 -
Neurospine Dec 2023The management of osteoporotic vertebral fractures (OVFs) in the elderly includes nonoperative treatment and vertebroplasty, but has not been established due to the...
The management of osteoporotic vertebral fractures (OVFs) in the elderly includes nonoperative treatment and vertebroplasty, but has not been established due to the diversity of patient backgrounds. The purpose of this study was to compare the impact of 3 treatment modalities for the management of OVF: orthotic treatment, percutaneous vertebroplasty (PVP), and balloon kyphoplasty (BKP). The method was based on an analysis of the latest RCTs, meta-analyses, and systematic reviews on these topics. No study showed a benefit of bracing with high level of evidence. Trials were found that showed comparable outcomes without orthotic treatment. Only 1 randomized controlled trial (RCT) showed an improvement in pain relief up to 6 months compared with no orthosis. Rigid and nonrigid orthoses were equally effective. Four of 5 RCTs comparing vertebroplasty and sham surgery were equally effective, and one RCT showed superior pain relief with vertebroplasty within 3 weeks of onset. In open trials comparing vertebroplasty with nonoperative management, vertebroplasty was superior. PVP and BKP were comparable in terms of pain relief, improvement in quality of life, and adjacent vertebral fractures. BKP does not affect global sagittal alignment, although BKP may restore vertebral body height. An RCT was published showing that PVP was effective in chronic cases without pain relief. Vertebroplasty improved life expectancy by 22% at 10 years. The superiority of orthotic therapy for OVF was seen only in short-term pain relief. Soft orthoses proved to be a viable alternative to rigid orthoses. Vertebroplasty within 3 weeks may be useful. There is no significant difference in clinical efficacy between PVP and BKP. Vertebroplasty improves life expectancy.
PubMed: 38171282
DOI: 10.14245/ns.2346936.468 -
Clinical Hematology International 2024Approximately 90% of patients with multiple myeloma experience significant pain from osseous involvement during their lifetime. Untreated osseous involvement results in... (Review)
Review
Approximately 90% of patients with multiple myeloma experience significant pain from osseous involvement during their lifetime. Untreated osseous involvement results in vertebral compression fractures, leading to negative consequences for quality of life. Vertebral augmentation procedures, including percutaneous vertebroplasty and kyphoplasty, offer better and faster pain control and likely lower morbidity compared with non-operative interventions. Our review provides an up-to-date summary of the indications, contraindications, timing, outcomes, and potential complications of vertebral augmentation procedures to guide practicing oncologists in effectively managing bone disease in patients with multiple myeloma.
PubMed: 38817694
DOI: 10.46989/001c.92984 -
Frontiers in Endocrinology 2023The aim of this study was to investigate the biomechanical stress of sandwich vertebrae (SVs) and common adjacent vertebrae in different degrees of spinal mobility in...
OBJECTIVE
The aim of this study was to investigate the biomechanical stress of sandwich vertebrae (SVs) and common adjacent vertebrae in different degrees of spinal mobility in daily life.
MATERIALS AND METHODS
A finite element model of the spinal segment of T10-L2 was developed and validated. Simultaneously, T11 and L1 fractures were simulated, and a 6-ml bone cement was constructed in their center. Under the condition of applying a 500-N axial load to the upper surface of T10 and immobilizing the lower surface of L2, moments were applied to the upper surface of T10, T11, T12, L1, and L2 and divided into five groups: M-T10, M-T11, M-T12, M-L1, and M-L2. The maximum von Mises stress of T10, T12, and L2 in different groups was calculated and analyzed.
RESULTS
The maximum von Mises stress of T10 in the M-T10 group was 30.68 MPa, 36.13 MPa, 34.27 MPa, 33.43 MPa, 26.86 MPa, and 27.70 MPa greater than the maximum stress value of T10 in the other groups in six directions of load flexion, extension, left and right lateral bending, and left and right rotation, respectively. The T12 stress value in the M-T12 group was 29.62 MPa, 32.63 MPa, 30.03 MPa, 31.25 MPa, 26.38 MPa, and 26.25 MPa greater than the T12 stress value in the other groups in six directions. The maximum stress of L2 in M-T12 in the M-L2 group was 25.48 MPa, 36.38 MPa, 31.99 MPa, 31.07 MPa, 30.36 MPa, and 32.07 MPa, which was greater than the stress value of L2 in the other groups. When the load is on which vertebral body, it is subjected to the greatest stress.
CONCLUSION
We found that SVs did not always experience the highest stress. The most stressed vertebrae vary with the degree of curvature of the spine. Patients should be encouraged to avoid the same spinal curvature posture for a long time in life and work or to wear a spinal brace for protection after surgery, which can avoid long-term overload on a specific spine and disrupt its blood supply, resulting in more severe loss of spinal quality and increasing the possibility of fractures.
Topics: Humans; Finite Element Analysis; Spinal Fractures; Spine; Fractures, Compression; Biomechanical Phenomena
PubMed: 37900139
DOI: 10.3389/fendo.2023.1259095 -
Journal of Biomedical Physics &... Oct 2023Percutaneous vertebroplasty employs bone cement for injecting into the fractured vertebral body (VB) caused by spinal metastases. Radioactive bone cement and also...
BACKGROUND
Percutaneous vertebroplasty employs bone cement for injecting into the fractured vertebral body (VB) caused by spinal metastases. Radioactive bone cement and also brachytherapy seeds have been utilized to suppress the tumor growth in the VB.
OBJECTIVE
This study aims to investigate the dose distributions of low-energy brachytherapy seeds, and to compare them to those of radioactive bone cement, by Monte Carlo simulation.
MATERIAL AND METHODS
In this simulation study, nine CT scan images were imported in Geant4. For the simulation of brachytherapy, I-125, Cs-131, or Pd-103 seeds were positioned in the VB, and for the simulation of vertebroplasty, the VB was filled by a radioactive cement loaded by P-32, Ho-166, Y-90, or Sm-153 radioisotopes. The dose-volume histograms of the VB, and the spinal cord (SC) were obtained after segmentation, considering that the reference dose is the minimum dose covered 95% of the VB.
RESULTS
The SC sparing was improved by using beta-emitting cement because of their steep gradient dose distribution. I-125 seeds and Y-90 radioisotope showed better VB coverage for brachytherapy and vertebroplasty techniques, respectively. Pd-103 seeds and P-32 radioisotope showed better SC sparing for brachytherapy and vertebroplasty, respectively. The minimum mean doses that covered 100% of the VB were 62.0%, 56.5%, and 45.0% for I-125, Cs-131, and Pd-103 seeds, and 28.3%, 28.6%, 32.9%, and 17.7%, for P-32, Ho-166, Y-90, and Sm-153 sources, respectively.
CONCLUSION
I-125 and Cs-131 seeds may be useful for large tumors filling the entire VB, and also for the extended tumors invading multiple vertebrae. Beta-emitting bone cement is recommended for tumors located near the SC.
PubMed: 37868948
DOI: 10.31661/jbpe.v0i0.2010-1210 -
Osteoporosis International : a Journal... Sep 2023We evaluated whether older adults who received kyphoplasty had reduced risk of mortality compared to those who did not. In unmatched analyses, those receiving...
UNLABELLED
We evaluated whether older adults who received kyphoplasty had reduced risk of mortality compared to those who did not. In unmatched analyses, those receiving kyphoplasty were at reduced risk of death but after matching on age and medical complications, patients who received kyphoplasty were at increased risk of death.
PURPOSE
In previous observational studies, kyphoplasty for treatment of osteoporotic vertebral fractures has been associated with decreased mortality compared to conservative management. The purpose of this research was to determine whether older adults who received kyphoplasty had reduced risk of mortality compared to matched patients who did not.
METHODS
Retrospective cohort study of US Medicare enrollees with osteoporotic vertebral fractures between 2017-2019 comparing patients who underwent kyphoplasty to those who did not. We identified 2 control groups a priori: 1) non-augmented patients who met inclusion criteria (group 1); 2) propensity-matched patients on demographic and clinical variables (group 2). We then identified additional control groups using matching for medical complications (group 3) and age + comorbidities (group 4). We calculated hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with mortality.
RESULTS
A total of 235,317 patients (mean (± standard deviation) age 81.1 ± 8.3 years; 85.8% female) were analyzed. In the primary analyses, those who received kyphoplasty were at reduced risk of death compared to those who did not: adjusted HR (95% CI) in group 1 = 0.84 (0.82, 0.87); and in group 2 = 0.88 (0.85, 0.91). However, in post hoc analyses, patients who received kyphoplasty were at increased risk of death: adjusted HR (95% CI) in group 3 = 1.32 (1.25, 1.41) and 1.81 (1.58, 2.09) in group 4.
CONCLUSION
An apparent benefit of kyphoplasty on mortality among patients with vertebral fractures was not present after rigorous propensity matching, illustrating the importance of comparing similar individuals when evaluating observational data.
Topics: Humans; Female; Aged; United States; Aged, 80 and over; Male; Spinal Fractures; Retrospective Studies; Fractures, Compression; Medicare; Spine; Osteoporotic Fractures; Kyphoplasty; Treatment Outcome
PubMed: 37233794
DOI: 10.1007/s00198-023-06796-6